Abstract 2928: The Long Term Prognostic Value of New Wall Motion Abnormalities During the Recovery Phase of Dobutamine Stress Echocardiography in Patients Receiving Acute Beta-Blockade
Objective: To estimate the prognostic value of new wall motion abnormalities (NWMA) during recovery phase of dobutamine stress echocardiography (DSE) compared to NWMA at peak.
Methods: 187 consecutive patients, with suspected or known coronary artery disease (CAD) underwent DSE and coronary angiography within 3 months. DSE was scored to assess NWMA as a marker of CAD at peak and recovery. Follow up was successful in all. All data were included to Cox regression models to identify independent predictors of cardiac events (cardiac death, myocardial infarction and late revascularization) more than 6 months after testing.
Results: Coronary angiography showed in 88 patients 1-vessel CAD; in 54 2-vessel CAD; in 45 3-vessel CAD. NWMA were present in 157 patients at peak and 170 patients during recovery. The sensitivity of DSE for CAD detection improved from 88% to 97% respectively. During follow up (mean 36 ± 28 months), 19 (10%) patients experienced cardiac death, 34 (18%) myocardial infarction and 77 (41%) underwent late revascularization. Univariable independent predictors of cardiac events included age (hazard ratio HR 1.0, 95% confidence interval CI 1.0 to1.1), dyslipidemia (HR 1.4, 95% CI 1.0–1.9), rest WMA (HR 1.4, 95% CI 1.1–1.6), NWMA (HR 1.2, 95% CI 0.9–1.4) at peak and NWMA (HR 1.3, 95% CI 1.1–1.6) at recovery of DSE. The best multivariable model to predict cardiac events included NWMA (HR 5.3, 95% CI 1.7–16.6) at recovery of DSE, after controlling for clinical data and peak DSE results (figure 1⇓).
Conclusions: This study illustrates that myocardial ischemia at recovery of DSE is an independent predictor of cardiac events and has an incremental value when compared to ischemia at peak.